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Dialysis Care for US Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season

Published online by Cambridge University Press:  06 May 2022

Lilia R. Lukowsky ,
Aram Dobalian ,
Kamyar Kalantar-Zadeh  and
Claudia Der-Martirosian
Lilia R. Lukowsky*
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
Aram Dobalian
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
Kamyar Kalantar-Zadeh
Affiliation:
Division of Nephrology and Hypertension, UCI School of Medicine, Orange, CA, USA
Claudia Der-Martirosian
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
*
Corresponding author: Lilia Lukowsky, Email: Lilia.Lukowsky@va.gov.
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Abstract

Objectives:

Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico.

Methods:

A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits.

Results:

The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29).

Conclusions:

There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

Keywords

dialysisdisastersend stage kidney diseasehurricanesPuerto Ricoveterans
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e187
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.
Copyright
© US Department of Veterans Affairs, 2022.

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